What Did People Use to Mask Surgical Pain Before Modern Anesthesia?

Gimly16 asks: What did people use for pain during surgery before modern anesthesia?

Other than ingesting alcohol and narcotics in sufficient doses to induce a state of analgesia, for most of its history, people in the West got through surgery with the aid of little more than forcible restraint and grit.

Drugs and alcohol were well known in the ancient world. Artifacts depicting opium poppies dating back to 4,000 BC have been found in the Levant, and evidence of Sumerian beer production dates to nearly 3,000 BC.; furthermore, henbane (Hyoscyamus niger), a member of the nightshade family, has been used to alleviate pain since the Babylonians began using it on toothaches around 2,250 BC.

By the classical age (Greco-Roman civilization), many nightshades, including the aforementioned henbane, were used to encourage sleep and manage pain. In fact, Homer even describes their application in The Odyssey where the witch, Circe, used magic herbs to subdue men and even restore Odysseus to life; these are presumed to include mandragora (mandrake) and datura (thornapple), both of which blunt the senses, mask pain and cause hallucinations.

Also at this time in Assyria and Egypt, “carotid compression,” presumably whereby the blood supply is cut off for a bit until the person passes out, was practiced during things like circumcision and eye surgery.

Few improvements in anesthesia were made through the Middle Ages, although by the end of the 13th century, some physicians, including Theodoric of Lucca, Italy, were soaking spongers with opium and a variety of nightshades and other herbs, including hemlock (which can induce paralysis to some extent ). The vapors from these sponges would then be inhaled (and sometimes the drippings applied directly to the nostrils), in order to sedate the patient.

Many historians credit Paracelsus (1493-1541), the famous physician, botanist and alchemist, with discovering the narcotic effect of ether in 1525 when he (apparently) experimented with its effects on chickens. Valerius Cordus (1515-1544), the botanist and physician, is believed to have first synthesized it, in what he called the “sweet oil of vitriol,” by distilling sulphuric acid and ethanol.

Gases became increasingly popular, and by the dawn of the 19th century, the benefits of nitrous oxide had been discovered; after this and the discovery of morphine by Friedrich Wilhelm Serturner in 1805, effective anesthesia for surgery was known, although it was not yet in widespread use.

In fact, in 1811, novelist Fanny Burney recounted her ordeal of undergoing a double mastectomy without the aid of any anesthetic:

M. placed me upon the mattress & spread a cambric handkerchief upon my face . . . [I] was instantly surrounded by the 7 men & my nurse . . . when the dreadful steel was plunged into the breast – cutting through veins – arteries – flesh – nerves . . . I began a scream that lasted unintermittingly during the whole time of the incision . . . [Furthemore] while the flesh resisted in a manner so forcible as to oppose & tire the hand of the operator [that he] was forced to change from the right to the left . . . I thought I might have expired. . . . I [even] felt the Knife tackling against the breast bone – scraping it!

According to Fanny, the entire operation of cutting and scraping lasted 20 minutes.

Other 19th century patients demonstrated less fortitude. While being operated on by the famous Dr. Robert Liston (the “fastest knife in the West End”) for a bladder stone, the patient lost his nerve, broke free from the restraining arms of Liston’s assistants, and fled the room. Liston is reported to have recaptured him and finally performed the surgery over the man’s screams.

By 1847, chloroform had been discovered, and was used during childbirth, for surgeries and dental procedures, although its side effects (including sudden death and liver damage) limited its popularity. Over the next 40 years, other gases were tried, but most were eventually discarded.

After discovery of cocaine in 1877, it was used as an anesthetic and even a nerve block by 1884. By 1901, the caudal epidural analgesia was realized (although it was actually discovered by accident when a patient was given an inadvertent injection).

Control of breathing was perfected by the early 1930s, and intravenous drugs, like the barbiturate, thiopental, were being used by the 1940s, as were muscle relaxants, beginning with curare.

Today, anesthesia is widespread and generally very safe, with a direct mortality risk of less than 1 in 250,000.